HIV Prevention Tops the News at AIDS 2014

Biomedical prevention has garnered more headlines than HIV treatment in recent years, and the news coming out of the 20th International AIDS Conference last week in Melbourne was no exception.

WHO PrEP Guidelines

Before the start of the conference, the World Health Organization (WHO) released new guidelines for HIV prevention, diagnosis, treatment, and care for key populations. The biggest story was its recommendation that gay and bisexual men who are at risk for HIV infection consider using antiretroviral drugs for pre-exposure prophylaxis, or PrEP, with some news outlets reporting that WHO had advised all men who have sex with men to start Truvada (tenofovir/emtricitabine).

The Food and Drug Administration's 2012 approval of Truvada for PrEP was based in part on data from the international iPrEx trial, which showed that once-daily Truvada reduced the risk of HIV infection for gay and bisexual men and transgender women by 44% overall, rising to more than 90% among participants with blood drug levels indicating regular use.

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"These recommendations highlight how HIV uninfected people can play an important role in getting to zero transmissions," iPrEx protocol chair and San Francisco AIDS Foundation medical director Robert Grant from the Gladstone Institutes told BETA. "These medications have a proven record of safety and effectiveness for treatment and prevention."

Presenting the guidelines at AIDS 2014, Fabio Mesquita, Brazil's HIV and STI health director, stressed that "evidence is the strongest that PrEP clearly can work" for gay men. There has only been one study of PrEP using tenofovir alone for people who inject drugs (the Bangkok Tenofovir Study), and demonstration projects are still warranted for sex workers and other populations.

Addressing the exaggerated media reports at a press briefing, International AIDS Society incoming president Chris Beyrer emphasized that the WHO guidelines state that PrEP is "an additional prevention option for men who want it" as part of a comprehensive set of services that would also include condoms, counseling, screening and treatment for other sexually transmitted infections, and addressing legal and policy barriers that impede access to services. Like birth control options for women, he explained, PrEP is just one option, and choices can change over a lifetime.

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